Page last updated: 29-JUN-2010

General Practice - Quality & Outcomes Framework

QOF Prevalence Rates for Scotland      

The content below is summarised in our Statistical Publication Notice June 2010.

Introduction

General practices in Scotland submit data to qualify for payments for quality of care as part of the Quality and Outcomes framework (QOF) of the General Medical Services contract.  These data are also useful to estimate the prevalence of the long term conditions included in the QOF, even though this is not their primary purpose.  (Here, prevalence refers to the proportion of a population that has a condition at a particular point in time.)

This page presents information on the reported national prevalence of the individual diseases or conditions within the clinical domain of the Quality & Outcomes Framework (QOF) for the six years 2004/05 to 2009/10.  For 2004/05 to 2008/09, final figures are shown (based on data verified and signed-off by the local NHS Board).  Added to these are initial figures for 2009/10, as calculated within the QOF data management IT system (QMAS) to support payments to practices.  Final figures for 2009/10 will be published on 28th September 2010 as part of the main, detailed QOF publication and may differ slightly from the ones shown here for some registers.  This is because:-

  • the initial figures are not always based on data from as many GP practices as the final ones (some practices may have had technical difficulties in submitting their correct register sizes)
  • the initial figures, calculated for the purposes of QOF payments, are derived in a different way to the final ones that ISD calculates and publishes.

Please refer to  Prevalence data in the QOF  for more information on prevalence, why it is important in the QOF, how it is used in the calculation of QOF payments, and for warnings to bear in mind when using and interpreting QOF prevalence figures.

Additional information on the prevalence of long-term conditions can be found in 'Measuring Long-Term Conditions in Scotland - A summary report' and in the Scottish Health Survey .

Summary Information

The table below presents Scotland level QOF prevalence rates (per 100 patients registered to a GP practice) by clinical area and year.  The full list of registers has been grouped according to whether the register definitions have stayed the same over the five full QOF years to date or whether they have been revised at some point.

Seven QOF registers have had a consistent definition since they were introduced in April 2004. These are: Asthma, Cancer, Coronary Heart Disease (CHD), Chronic Obstructive Pulmonary Disease (COPD), Hypertension, Hypothyroidism and Stroke and Transient Ischaemic Attack (TIA).

Four QOF registers maintained a consistent definition in 2004/05 and 2005/06 but were subject to revision from 2006/07. This means that the prevalence statistics for 2006/07 onwards are not directly comparable to those for earlier years.  These four registers are: Diabetes Mellitus, Epilepsy, Left Ventricular Dysfunction and Mental Health.

A series of new registers were introduced to the QOF for 2006/07, of which eight retained a consistent definition through to 2009/10, which means that prevalence rates can be compared over a four year period.  These registers are: Atrial Fibrillation, Chronic Kidney Disease (CKD), Dementia, Depression, Conditions Assessed for Depression, Heart Failure, Learning Disabilities and Obesity.

A further two registers, first included in the QOF for 2006/07, were redefined for 2008/09.  This means that for these registers, Palliative Care and Conditions Assessed for Smoking, prevalence is comparable between 2006/07 and 2007/08 and between 2008/09 and 2009/10 but is not comparable over the 4 years.

One register, Primary Prevention of Cardiovascular Disease, was introduced to the QOF for the first time in 2009/10 and is included in the table below.

Further information on register definitions, and changes to them for 2006/07, 2008/09 and 2009/10 can be found in the following documents

QOF National Prevalence rates by Register and Year (April-March), Scotland1,2,3
per 100 patients registered with general practices; 2004/05-2009/10

Click on the specific register name for more detailed information and interpretation.

 

2004/05
(final)

2005/06
(final)

2006/07
(final)

2007/08
(final)

2008/09(final)

2009/10 (initial)
Unchanged Registers

Asthma
Cancer
Coronary Heart Disease
COPD
Hypertension
Hypothyroidism
Stroke and TIA
Atrial Fibrillation
Chronic Kidney Disease
Dementia
Registers for Depression Indicators:
   Conditions for Depression Screening
   Diagnosis of Depression
Heart Failure
Learning Disabilities
Obesity
Primary Prevention of Cardiovascular Disease

5.4
0.5
4.5
1.9
11.5
2.8
1.8
-
-
-

-
-
-
-
-
-

5.4
0.7
4.5
1.8
12.0
3.0
1.9
-
-
-

-
-
-
-
-
-

5.5
0.9
4.5
1.8
12.5
3.1
2.0
1.3
1.8
0.6

7.2
6.2
0.9
0.4
7.0
-

5.5
1.1
4.5
1.9
12.9
3.2
2.0
1.3
2.7
0.6

7.3
6.9
0.9
0.4
7.3
-

5.7
1.3
4.4
1.9
13.1
3.4
2.0
1.3
3.0
0.6

7.4
7.7
0.8
0.5
7.0
-

5.9
1.5
4.5
2.0
13.9
3.6
2.1
1.4
3.2
0.6

7.8
8.3
0.9
0.6
7.3
0.5
Redefined Registers

Diabetes Mellitus
  Register in 2004/05 and 2005/06
  Register from 2006/07 to 2009/10
Epilepsy
  Register in 2004/05 and 2005/06
  Register from 2006/07 to 2009/10
Left Ventricular Dysfunction
  Register in 2004/05 and 2005/06
  Register from 2006/07 to 2009/10
Mental Health
  Register in 2004/05 and 2005/06
  Register from 2006/07 to 2009/10
Palliative Care
  Register in 2006/07 and 2007/08
  Register in 2008/09 and 2009/10
Conditions Assessed for Smoking
  Register in 2006/07 and 2007/08
  Register in 2008/09 and 2009/10


3.2
-

0.7
-

0.6
-

0.5
-

-
-

-
-


3.4
-

0.7
-

0.6
-

0.6
-

-
-

-
-


-
3.5

-
0.7

-
0.6

-
0.8

0.1
-

20.4
-


-
3.7

-
0.7

-
0.6

-
0.8

0.1
-

22.0
-


-
3.9

-
0.7

-
0.6

-
0.8

-
0.1

-
23.2


-
4.2

-
0.7

-
0.6

-
0.9

-
0.2

-
24.3
Data Source: QMAS Database - 2009/10 data as at 3rd June 2010
Excel version of this table excel download icon (25 Kb) also available for download

Notes:

  1. Figures are as at the QOF 'National Prevalence Day' applicable to each year (14th February in each year from 2004/05 - 2007/08; 31st March for 2008/09 and 2009/10). See Prevalence data in the QOF for more information.
  2. Rate calculations use practice list sizes (i.e. numbers of registered patients) as at 1st January in each year, obtained from the Community Health Index (CHI) database.  All QOF prevalence rates are calculated using the whole practice population, with no restriction for age, even if the registers themselves are age-restricted.
  3. The rates for 2004/05 - 2008/09 inclusive were calculated using all available QOF register data from practices.  They were calculated by taking the sum of all the practice register sizes, dividing by the sum of all practice list sizes where the practice had a valid register, and then multiplying by 100 to give the prevalence rate per 100 registered patients.   The 2009/10 initial figures are the national prevalence rates calculated within the QMAS database in order to then adjust each practice's QOF payments.  Final figures for 2009/10 will be published as part of ISD's full report on the QOF for 2009/10 on 28th September 2010, and may differ from the initial figures shown here. This is because:
       - the initial figures are not always based on data from as many GP practices as the final ones (some practices may have had technical difficulties in submitting their correct register sizes)
       - the initial figures, calculated for the purposes of QOF payments, are derived in a different way to the final ones that ISD calculates and publishes.  The methodology used by QMAS in the calculation of national prevalence is described further in the General Medical Services Statement of Financial Entitlement for 2009/10 , annex G (page 297).

Detailed Information and Interpretation

Asthma

The prevalence statistics provided here are based on annual registers of practice patients with a diagnosis of asthma, excluding those who have had no prescription for asthma-related drugs in the last 12 months.   Asthma remains a clinical area under the QOF, having been included in the framework from its first year, 2004/05. The current definition is consistent with previous definitions used since 2004/05.   The QOF-reported national prevalence rate for asthma has risen slightly from 5.4% in 2004/05 and 2005/06 to an initial 5.9% for 2009/10.  The increase may have been due, at least in part, to improved case ascertainment by practices over time.

More information on why asthma was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of asthma in Scotland (including consultation rates in general practice in 2003/04 to 2008/09) is available on ISD's Practice Team Information (PTI)  web pages.

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Atrial Fibrillation

Atrial fibrillation is a heart rhythm disorder.   The QOF register definition applies to people with an initial event; paroxysmal (intermittent); persistent and permanent atrial fibrillation. Note that this register was introduced to the QOF in April 2006 so that there are now four years of comparable data. National prevalence rates in Scotland remained constant at 1.3 per 100 patients over the first three years before a slight rise to 1.4 per 100 in 2009/10.

More information on why atrial fibrillation was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

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Cancer

The QOF prevalence statistics provided are based on all cancers (excluding non-melanomatous skin lesions) but include only patients diagnosed after 1st April 2003.  The current definition is consistent with previous patient selections used since 2004/05.  Crude (non age-adjusted) national prevalence reported under the QOF has increased from 0.5% in 2004/05 to 1.5% in 2009/10.  Because of the date cut-off in the definition of the register, this rise primarily reflects the cumulative accrual of new cancer cases onto practice registers with each passing year rather than giving any indication of a true increase in cancer prevalence.

More information on why cancer was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of cancer in Scotland is available on the following websites:

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Primary Prevention of Cardiovascular Disease

This is a new register for 2009/10 and counts those who are at risk of developing Cardiovascular Disease (CVD) so that this risk can be assessed.  It is not a count of those with the condition.  The register definition is 'patients with a new diagnosis of hypertension (excluding those with pre-existing CHD, diabetes, stroke and/or TIA) recorded between the preceding 1 April to 31 March'.

Nationally 0.5% of patients fitted these criteria for 2009/10.  Since this is the first year this register has been in the QOF there are no comparative data for previous years.

More information on why CVD Primary Prevention was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

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Coronary Heart Disease

Coronary Heart Disease has remained a clinical area within the QOF, with consistent selection criteria, since QOF implementation in 2004/05.   The QOF-reported national prevalence of CHD has remained stable since then, at around 4.5%.

More information on why coronary heart disease was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of CHD in Scotland is available on the following websites:

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Chronic Kidney Disease

The QOF indicators for Chronic Kidney Disease (CKD) are based on a practice register of people aged over 18 with chronic kidney disease from any cause.  Inclusion in the register is based on estimated Glomerular Filtration Rate (eGFR), a measure of kidney function.  Those whose kidney function is assessed at stage 3-5 based on this test are eligible for inclusion on the register. Note that this register was introduced to the QOF in April 2006 so data are only available for four years.

For 2006/07 the final prevalence rate reported from QOF registers was 1.8%, much lower than the true figure expected to emerge over time.  The establishment of CKD registers in Scotland was dependent on the existence of systems to support eGFR testing.  Unfortunately, in some areas there were delays in introducing eGFR testing and as a result fewer patients than expected were included on CKD registers.   By 2007/08 the final rate had risen to 2.7%, an increase that was expected and likely to be due largely to improvements in case ascertainment, supported by the improved availability of eGFR testing in Scotland.  Further increases to 3.0% for 2008/09 and an initial 3.2% in 2009/10 are likely to reflect ongoing improvements in formal diagnosis of stage 3-5 Chronic Kidney Disease in Scotland.

More information on why Chronic Kidney Disease was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of chronic kidney disease in Scotland is available on the following website:

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Chronic Obstructive Pulmonary Disease (COPD)

COPD has remained a clinical area within the QOF, with consistent selection criteria, since QOF implementation in 2004/05. The prevalence of COPD as reported through general practice QOF registers has remained within a range of 1.8% - 2.0% over the 6 years the QOF has been in operation.

For 2004/05 and 2005/06 QOF definitions did not allow patients to be on both asthma and COPD registers ? thus patients with a degree of reversible airways disease were not included on the COPD register.  From 2006/07 the rules were revised to allow patients to be included on both COPD and asthma registers.  Because of this any comparisons of COPD prevalence before and after this time should be made with caution.

More information on why COPD was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the prevalence of COPD in Scotland is available at:

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Dementia

The definition of this indicator applies to all people diagnosed with dementia either directly by the GP or through referral to secondary care. This register was introduced in April 2006 and there are no directly comparable statistics available for previous years. The final national prevalence rates for 2006/07 to 2008/09 and the initial national prevalence for 2009/10 are 0.6% in each case.  This appears contrary to expectations that further identification and recording of dementia cases over time might have led to increases in reported prevalence rates of dementia as derived from QOF registers.

More information on why dementia was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of dementia in Scotland is available on ISD's Practice Team Information (PTI) web pages.

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Depression

Since 2006/07 there have been two different QOF registers and indicators related to depression, each based on different criteria. The first indicator relates to case finding of depression among patients with diabetes and/or Coronary Heart Disease (CHD).  The second indicator relates to any patient newly diagnosed with depression since the preceding 1st April (e.g. for the 2009/10 QOF year, this would mean patients newly diagnosed after 1st April 2009). Both of the depression indicators were introduced to the QOF in April 2006 and there are no directly comparable statistics available for previous years in either case.

The register for the depression 1 indicator counts patients with diabetes and/or CHD.  The indicator measures whether patients with either or both of these conditions have been assessed for depression.   Nationally, 7.2% of patients registered to general practices at 14th February 2007 had diabetes, CHD, or both.  This rose to 7.4% at 31st March 2009 and 7.8% from initial figures for 31st March 2010.  This rise is largely due to a rise in the prevalence figures for diabetes over the same time period (from 3.5% to 4.2%).

The register for the depression 2 indicator counts patients with newly diagnosed depression.   The indicator then measures whether the severity of the depression has been assessed using an assessment tool validated for use in primary care.   An unusual feature has been noted within the technical business rules that define how clinical IT systems should count the register sizes for this indicator. Although the measurement of achievement against this indicator excludes patients diagnosed prior to the preceding 1st April (e.g. 1st April 2009 in the case of the 2009/10 QOF year), the pre-exclusion register size is used for prevalence purposes. For some practices with a long history of recording depression electronically in the clinical record (and where the depression is not recorded as having been resolved), a larger register size will be reported in comparison to an otherwise equivalent practice that has not been recording depression cases electronically over as long a time period.  The final figures for 2006/07 indicated that nationally 6.2% of patients registered to general practices at 14th February 2007 had been newly diagnosed with depression at some point.  The final figure for 2008/09 and the initial one for 2009/10 are both higher, at 7.7%. and 8.3% respectively. These increases will, at least in part, be due to the cumulative nature of this register.

More information on why depression was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of depression in Scotland is available on ISD's Practice Team Information (PTI)  web pages.

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Diabetes Mellitus

Although indicators related to Diabetes Mellitus have existed in the QOF since April 2004, there has been a change in the selection criteria for counting patients on QOF diabetes registers. Since April 2006, the definition includes all patients aged 17 years and over with diabetes mellitus defined by clinical (Read) codes specific to Type 1 or Type 2 diabetes. Previously there was a wider range of codes accepted under the definition although the age constraint has remained consistent. The prevalence statistics for 2006/07 onwards are therefore not directly comparable with those for 2004/05 and 2005/06.

It should also be noted that QOF prevalence rates use the whole practice population as their denominator, and in the case of diabetes do not exclude patients aged less than 17, even though the register itself is age limited.  This has the effect of artificially lowering the prevalence rate, so that the prevalence rates for diabetes reported through the QOF are an underestimate of the true prevalence. The extent of the underestimate depends on the size of the practice population under 17 years.

The QOF-reported prevalence of Diabetes Mellitus has increased from 3.5% at 14th February 2007 to 4.2% at 31st March 2010. This increase may be due, at least in part, to improved case ascertainment by practices, but it is consistent with the increase in the prevalence of type 2 diabetes in Scotland reported elsewhere.

It should be further noted that although the practice must record whether the patient has Type 1 or Type 2 diabetes, this level of detail is not recorded within QMAS (the national IT system that supports the calculation of QOF achievements and payments). Therefore the register size or prevalence rate cannot be split by type of diabetes.

More information on why diabetes mellitus was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of diabetes in Scotland is available on the following websites:

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Epilepsy

Although indicators for Epilepsy have existed in the QOF since April 2004, there has been a change in the selection criteria for eligible patients. Since April 2006, the definition of the register has included patients aged 18 and over, whereas previously it included those 16 and over.  It should be noted that QOF prevalence rates use the whole practice population as their denominator, and do not exclude patients aged less than 18 (or 16). This has the effect of artificially lowering the prevalence rates reported for epilepsy through the QOF so that they are an underestimate of the true prevalence.

The prevalence statistics for 2006/07 onwards are therefore not directly comparable with those for 2004/05 and 2005/06.  Since 2006/07 the national prevalence rate derived from QOF registers in Scotland has remained consistent at 0.7%.

More information on why epilepsy was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of epilepsy in Scotland is available on the following websites:

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Heart Failure

Patients with Heart Failure are included on two QOF registers, one of which is a subset of the other.  The first of these registers counts all patients coded by general practices as having heart failure.  This register, and accompanying indicators, was introduced to the QOF in April 2006.  The second register counts the subset of patients who have heart failure and left ventricular dysfunction (LVD).  LVD was included as a register on the original QOF (2004/05 and 2005/06), but at that time the register related to patients on the coronary heart disease register who also had LVD. LVD was a subset of CHD in previous years, but all these patients are now counted under heart failure registers.  This means that LVD rates for the first two years of the QOF are not directly comparable with LVD rates for 2006/07 onwards.

National QOF prevalence figures for heart failure between 2006/07 and 2009/10 were consistently around 0.8 - 0.9% and rates for LVD were 0.6%.

More information on why heart failure was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

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Hypertension

Hypertension has remained a clinical area within the QOF with consistent selection criteria since QOF implementation in 2004/05. The final national prevalence figure for 2005 was 11.5%, and this has risen since to an initial figure of 13.9% for 2010. This increase may be due, at least in part, to improved case ascertainment by practices over time. However the risk of hypertension rises sharply with age and the figures are likely to reflect a real increase in the numbers of people with hypertension in Scotland, a country with a rising proportion of older people.

More information on why hypertension was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of hypertension in Scotland is available on the following websites:

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Hypothyroidism

Hypothyroidism (having an under-active thyroid) has remained a clinical area within the QOF, with consistent criteria for counting patients, since the QOF was introduced in 2004/05.   Prevalence rates for this condition as reported through the QOF have risen gradually from 2.8% in 2005 to an initial 3.6% for 2010.  This increase may be due, at least in part, to improved case ascertainment by practices over time but is also likely to reflect the gradual ageing of the population in Scotland (as this condition is common in older age groups).

More information on why hypothyroidism was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of hypothyroidism in Scotland is available on ISD's Practice Team Information (PTI) web pages.

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Learning Disabilities

This register includes all people aged 18 and over with learning disabilities. Note that this register was introduced to the QOF in April 2006 and that there are no directly comparable statistics available for previous years. It should be noted that QOF prevalence rates use the whole practice population as their denominator, and do not exclude patients aged less than 18. This means that the prevalence rates for learning disabilities as reported through the QOF appear lower than they would be if this age group was excluded from the population denominator.

The QOF-reported national prevalence of Learning Disabilities has increased from 0.4% in 2007 to an initial 0.6% for 2010.  These figures are both lower than estimates of overall population-based prevalence of learning disabilities as given in QOF guidance (around 2% across all ages).  However, a high proportion of patients with learning disabilities may not be recorded by practices as having such disabilities, for example if these patients do not attend the practice for other reasons.

More information on why learning disabilities were included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on learning disabilities is available on the following websites:

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Mental Health

Although indicators for Mental Health have existed in the QOF since April 2004, there has been a change in the selection criteria used to count patients on QOF mental health registers. Since April 2006, the definition has included only patients with serious mental illness, defined as schizophrenia, bipolar affective disorder or other psychoses.  Previously, patient selection was based on more a more generalised set of mental health conditions and on the further condition that the patient required, and had consented to, regular follow-up. The prevalence statistics for 2006/07 onwards, although comparable with each other, are not therefore directly comparable with those for 2004/05 and 2005/06.

The prevalence rates for this selected set of mental health conditions, as derived from QOF registers, remained consistent from 2006/07 to 2008/09 at 0.8% with a slight increase to 0.9% in the initial figures for 2009/10.

More information on why mental health was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of mental health problems in Scotland is available on the following websites:

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Obesity

The definition of obesity used for the QOF applies to all people aged 16 years and over with a Body Mass Index (BMI) of at least 30 (that is greater than or equal to 30kg per height in metres squared), recorded in the previous 15 months. Note that this register was introduced to the QOF in April 2006 and that there are no directly comparable statistics available for previous years.

The QOF-reported national prevalence of obesity for 2007 was 7.0%; this rose to 7.3% for 2008 but was back down to 7.0% for 2008/09.  In 2009/10 the national figure initially calculated for payment purposes was back up to 7.3%.  All of these figures are much lower than the generally accepted rates (for example the 2008 Scottish Health Survey reported that 26% of men and 27.5% of women aged over 16 years were obese).  A small part of the difference is due to the fact that QOF prevalence rates use the whole practice population as their denominator and do not exclude patients aged less than 16, meaning that the prevalence rates are lower than they would be if this age group was excluded from the population denominator.  Another likely reason is that not all people who are obese are recorded as such by general practices, particularly if they are young and have not experienced any particular health-related difficulties.  However, there is still scope for case ascertainment of obesity by practices to improve over time.

More information on why obesity was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on obesity is available on the following websites:

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Palliative Care

The definition of the palliative care register has changed since it was first introduced in April 2006.  In 2006/07 and 2007/08 it applied to all practice patients aged 18 and over who were identified as being in need of palliative or supportive care.   From April 2008, the age restriction was removed so that the register now includes patients of all ages.  This means that the figures for 2008/09 onwards are not directly comparable with those for earlier years.  This register is particularly difficult to interpret as by its very nature patients join and leave the list over a short period of time.  Therefore, the number of patients included on a practice palliative care register is a snapshot of the situation at the time the register was taken (14th February 2007, 14th February 2008, 31st March 2009, 31st March 2010 respectively) and may not be a true reflection of practice prevalence throughout the rest of the year.

The initial 2009/10 QOF-reported prevalence rate for palliative care was 0.2%.  As palliative care registers are subject to particular fluctuations over time, the 'Adjusted Disease Prevalence Factor' (see Prevalence data in the QOF for further explanation of this term) has not been applied in Scotland for calculating QOF payments in relation to palliative care.

More information on why palliative care was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

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Conditions Assessed for Smoking

The register to support two "new" smoking indicators (actually a reworking of several smoking indicators included in the original QOF) was introduced to the QOF in April 2006. However it is important to stress that a national prevalence of smoking cannot be derived from this register or previous indicators.   The smoking indicator sets relate to the smoking status of people with one or more selected chronic conditions.  The 'conditions assessed for smoking' register identifies how many patients at each practice have one or more of these conditions.

For 2006/07 and 2007/08 the register counted patients with any of the following conditions:  Coronary heart disease, stroke or TIA, hypertension, diabetes, COPD or asthma.

In 2008/09, the definition of the register changed now includes not only the conditions listed above but also added the following: Schizophrenia, bipolar affective disorder or other psychoses.

The QOF-reported  national prevalence of the listed chronic conditions for 2006/07 was 20.4% - that is to say, around one fifth of patients registered to general practices had one or more of the six conditions included in the register at the time.  By 2007/08 the equivalent figure had risen slightly to 22.0%, likely to be due mainly to increases in the recorded prevalence of hypertension and diabetes.

In 2008/09, the first year that the extra mental health conditions were included in the register, the figure was 23.2% rising to an initial figure of 24.3% in 2009/10. These prevalences for the 2008/09 and 2009/10 are not comparable to those from earlier years because of the inclusion of these extra conditions.

More information on smoking indicators within the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on smoking is available on the following websites:

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Stroke and Transient Ischaemic Attack

Stroke and TIA has remained a clinical area within the QOF, with consistent selection criteria for including patients on the register, since the QOF was introduced in 2004/05. Reported national prevalence rose from 1.8% for 2004/05 to 2.0% in 2006/07, 2007/08 and 2008/09.  For 2009/10 an initial prevalence of 2.1% has been recorded.  The increase in the initial years of the QOF may be due, at least in part, to improved case ascertainment by practices over time and an ageing population in Scotland.

More information on why stroke and TIA was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of stroke in Scotland is available on the following websites:

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